Lola&Lykke Experts Answer: Psychotherapy can help treat the emotional crisis of infertility

Undesired infertility happens to almost 1 in every 8 people during their adult life. It is often a significant crisis that touches upon many different aspects of life, from personal experience to romantic relationships. Unwanted infertility can happen to people in many different circumstances; it can manifest as recurring failed pregnancies or miscarriages, or as the lack of a suitable partner when one’s biological clock is ticking.

Infertility can be classified as either primary or secondary infertility. Primary infertility means difficulties having a first child, while secondary infertility is a situation where the family already has a child or children but struggle to begin a new pregnancy or are experiencing recurring miscarriages.

Infertility is an emotional crisis

The physical causes of infertility can, in most cases, be treated with different medical treatments, but the emotional crisis of infertility is often overlooked. Emotional experiences surrounding infertility can and often should be treated with therapy. Therapy can offer help and support in a variety of different life situations.

Sadness and fear are common feelings surrounding infertility which, when prolonged, can cause depression and anxiety. Infertility can also be a traumatic experience which can trigger post-traumatic stress disorder (PTSD).

Infertility crisis is unique compared to other types of crises because hope and hopelessness can be like a rollercoaster ride, fluctuating over many months or even years. The focus of the crisis—whether sadness, worry, or fear for the future—can shift back and forth over time. Infertility can cause a lot of negative feelings which you have to process both as an individual and together as a couple. In addition to sadness and fear, you can also experience feelings of failure, loss of control, shame, unworthiness, jealousy, unfairness, and bitterness. There’s really no limits here, you can be feeling all sorts and some emotions can also be difficult to put to words.

The permanency of infertility diagnosis, poor prognosis, or losing a much-wanted child can make infertility a traumatising experience. A long-lasting treatment plan can include several disappointments and hardships which can at some point exceed the point of psychological resilience.

For someone who is in the middle of an infertility crisis, there may be a constantly present fear that the meaning of life has been challenged. An outsider might struggle to understand why someone who is childless is mourning something that has never existed and is not therefore “lost”, or why they are afraid to face the permanence of childlessness when their infertility treatments are still ongoing. Infertility crisis can make people question their basic values and principles of a good quality of life. It challenges their hopes and dreams for the future in such a profound way where this kind of anticipatory sadness and fear are almost always felt. Studies have shown that the stress caused by infertility crisis is as high as for those who are dealing with AIDS or cancer.

Infertility treatments are also often psychologically very demanding and can affect a relationship in many ways. The treatments are often accompanied by worries and fears, and it is important to discuss these with the medical team and proactively ask questions. Different stages of infertility treatments often come with feelings of hope and hopelessness, as well as disappointment, sadness, frustration, and treatment fatigue.

Pregnancy ending in a miscarriage is also a large crisis in itself. When this happens multiple times, the crisis deepens. With miscarriages there is often a clearly defined phase of shock, which is followed by a mourning period. Sometimes people get stuck in the mourning stage, and the prolonged sadness can cause depression.

Therapy treatment for infertility crisis

Infertility and its treatments

In my clinic I see emotional stress caused by infertility and its medical treatments, many types of painful feelings as well as the impact that infertility has on a romantic relationship. My clients attend therapy either as one-on-one or as couples therapy.

For many, infertility is the first experience of a crisis that shakes the foundations of life and that you can only control up to a point. You can educate yourself, follow rules and guidance, take the doctor’s prescriptions; but at the end of the day, the crisis cannot be managed by just successfully getting pregnant. Unwanted infertility can—possibly for the first time in someone’s life—cause a strong feeling of inability to control your life when things do not go as hoped or planned. Suddenly, no matter how much physical, emotional and often financial effort goes into trying to solve the problem, success is not guaranteed. Even the most determined efforts might not pay off.

If prior to the infertility crisis there has been other serious issues in life, such as untreated traumatic childhood experiences, the infertility crisis can have even more profound an effect. Previous feelings of unworthiness and failure can arise again. This may lead to abruptly stopping infertility treatments even when medically there were still many options available and the success rates favourable. But in these cases, people can be hesitant to take the chance because of the fear of another failure.

During infertility treatments there are moments where you have to stop and think about options for the future. This could be when changing the form of the treatment (e.g. from insemination to IVF, or from IVF to donated cells) or simply when facing treatment fatigue. These moments often spark conversations and the weighing of options in therapy.

Sometimes people have to stop and face the question of ending treatments without the desired result i.e. a successful pregnancy. At this stage it can be helpful to discuss other options for becoming a parent, or even considering making a decision to remain childless. One of my clients recently said, “stopping at this stage doesn’t even feel like giving up when we have been trying for so long”. However, often ending the treatment without success requires a long process of acceptance, where psychotherapy can be immensely helpful.

As treatment usually involves a couple, different or differently timed experiences, thoughts, and emotions must be taken into account. On the other hand, for someone attending infertility treatments alone, the support from a psychotherapist can be even more meaningful as they do not have a partner to share the experiences and feelings with.

Pregnancy followed by a long time of infertility

If the infertility treatment has mostly focused on the medical treatment and the emotional crisis has been brushed aside, difficult feelings may arise when the acute part of the crisis is over and the wish for a pregnancy has been fulfilled.

A pregnancy after infertility treatments does not always only involve positive feelings and a profound feeling of success; rather, there can be a spectrum of different emotions. If there have been traumatic aspects to the infertility crisis, the expectant mother or father may see threats even where there are none or anticipate new disappointments and setbacks, even when the pregnancy is going well. “Each time I go to the bathroom I’m afraid to see blood, even when I’ve had a textbook pregnancy so far”, said one of my clients during their pregnancy after having previously experienced a late-stage miscarriage.

Sometimes, the expectant mother or their partner has a hard time bonding with the unborn child, because the thought of losing them and the anguish that would cause feels easier to deal with if you have not bonded with the baby in utero. This type of suppressing of positive feelings can cause problems in bonding later on, and in any case most likely does not even lessen the pain of a possible loss.

If such fears or suppressed feelings happen during your pregnancy, a visit to see a psychotherapist or an antenatal psychotherapist may be helpful.

Loss of pregnancy

Pregnancy ending in miscarriage, stillbirth, or abortion due to the baby’s health, is often a very difficult or traumatic experience. Sadly, it is very common to hear people who have gone through these to have their feelings unvalidated. It is not uncommon that someone who has lost a pregnancy gets told to “just try again”, or to have people state that miscarriages are common and nature’s way of getting rid of nonviable foetuses. These types of comments can really hurt someone in mourning.

Sharing painful feelings of loss and getting proper emotional support can help people to cope with the loss of a pregnancy. As well as sadness, many people who have lost pregnancies can have other psychological symptoms such as depression, anxiety, and post-traumatic stress. If left untreated, these can make the healing process even more difficult and affect their willingness and ability to look into the future. It is also possible that untreated psychological symptoms may slow down the start of a possible future pregnancy.

Relationships

Infertility can cause problems and crises in relationships. The different stages of crises often do not happen at the same time for the partners, and the grief from a miscarriage can be dealt with in different ways. It is quite common that the partners do not feel understood or supported during some stages of an infertility crisis.

Sometimes the fear and worry caused by infertility and its potential permanence can lead someone to question their relationship if it appears like it may not offer them the chance to fulfil important dreams and life goals.

Couples infertility therapy often focuses not only on the infertility itself but also on the importance of processing and voicing of feelings. Sometimes voicing your feelings out loud can feel almost like an insurmountable effort, and those feelings may bottle up and worsen, leading sometimes to anxiety or depression. If these feelings of vulnerability are not shown or shared with the partner, it can cause the partners to start to drift apart. Sometimes a constructive way of showing your feelings can feel very difficult, and then the frustration and hopelessness that often come with infertility can instead present as aggression. In couples therapy both partners can work on showing their feelings in such a manner that they both feel safe.

Sometimes infertility crisis can leave long-term wounds in a relationship. The crisis may have been handled only with medical means, and the emotional crisis has been overlooked. Even if the infertility treatments are successful and a baby has turned the couple into a family, the unmet needs during the infertility crisis can leave their mark on the relationship and surface later as feelings of mistrust during any difficult times. In these kinds of situations, the actions of the partner are perceived in a context that has been negatively impacted by the infertility crisis. The burden of an emotionally unresolved crisis can have an impact on the wellbeing and happiness of a relationship even after a baby is born. Couples therapy can still help to address these problems even later on.

Sexuality

As a sexual therapist I also deal with sexual problems caused by infertility, which are not uncommon in prolonged cases.

Long and unfulfilling attempts to get pregnant will impact on a couple’s sex life in many ways. Sex may start to feel like a chore instead of a way to gain pleasure and show affection. Sexual desires can temporarily disappear almost altogether in stressful situations, but sex must still be had – at least during the time of ovulation each month. If the situation goes on for a long time, it can lead to sexual dysfunction for either one of the partners.

Hormonal medications, invasive treatments and recovery can also have a negative effect on your sex life.

Infertility can cause negative feelings for your own body when your body repeatedly ‘lets you down’. Seeing your body as somehow ’broken’ can also impact sexuality.

Sexual therapy can be attended alone or as a couple and it offers a safe place to talk through any thoughts that may arise.

Parenthood

Sometimes the experience of infertility does not end after having a child, and both past and continuing infertility and possible recurring miscarriages can paint the picture of parenthood a certain way. This should also be worked upon in therapy, especially so that you would not pass these negative feelings to the child in one way or another.

Sometimes the birth of a baby can trigger grief from previous miscarriages when it becomes evident what you have lost. This in turn can cause postpartum depression and/or problems in bonding with the baby.

Untreated infertility crisis can lead to impossible expectations in parenthood where even the smallest and most mundane ‘failure’ can seem huge. For example, high expectations can be set for vaginal birth, successful breastfeeding, unending patience with a toddler in their terrible twos, or for your own wellbeing during various challenges of parenthood. If you then ‘fail’, self-blame and guilt can feel extremely heavy to bear. This can cause a negative cycle where your own feelings of guilt cause bad feelings, and the bad feelings make you much more likely to ‘fail’ in challenging parenting situations.

Often people who have experienced losses of pregnancy or prolonged infertility may also feel more fear and worry for their child’s wellbeing and future, which can lead to anxiety, fear, and overprotectiveness. This is not the same as the normal fears and worries of a parent, but rather something more profound that can impact on everyday life.

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Finally…

As a psychotherapist I see many emotional impacts of unwanted infertility. I would like to remind you that many families that succeeded in infertility treatments are living a perfectly normal and happy family life with its usual challenges. Even without an infertility crisis, many families face different types of stressors, relationship issues, sexual problems, and parenting challenges.

Jenni Huhtala
Psychotherapist, specialised family therapist, couples therapist, sexual therapist

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